Microscopic colitis is an inflammatory condition affecting the colon. It is characterized by inflammation not visible during a standard colonoscopy but identified through microscopic examination of tissue samples. The primary symptom is chronic, watery diarrhea, which can significantly impact daily life.
Understanding Microscopic Colitis
Persistent watery diarrhea is the most common symptom, often severe and sudden in onset. Other symptoms include abdominal pain, cramping, bloating, and fatigue. To diagnose microscopic colitis, a gastroenterologist performs a colonoscopy, during which the colon lining appears normal to the naked eye. However, biopsies are taken from different areas of the colon and examined under a microscope. Microscopic analysis reveals specific changes, confirming the diagnosis.
Microscopic colitis encompasses two main types: collagenous colitis and lymphocytic colitis. In collagenous colitis, a thicker than normal layer of collagen develops in the colon’s lining. Lymphocytic colitis shows an increased number of white blood cells called lymphocytes within the colon’s lining. Despite these microscopic differences, both types present with similar symptoms and are managed with comparable treatment approaches.
Medical Treatment Approaches
Managing microscopic colitis often begins with over-the-counter options for symptom control. Anti-diarrheal medications, such as loperamide, are used to reduce the frequency and urgency of bowel movements, especially in mild cases. Bismuth subsalicylate, commonly known as Pepto-Bismol, also alleviate diarrhea. These agents primarily address symptoms rather than the underlying inflammation.
For more direct treatment of inflammation, budesonide is a first-line prescription medication. This corticosteroid acts locally within the gut, reducing inflammation with fewer systemic side effects. Budesonide works by suppressing the immune response in the inflamed colon tissue. While effective for inducing remission, symptoms can recur once treatment is discontinued.
When initial treatments are insufficient or symptoms are severe, other medications that modulate the immune system are considered. Immunomodulators like azathioprine or methotrexate suppress the immune system to reduce inflammation. These are reserved for cases that do not respond to budesonide or for individuals who experience frequent relapses. Biologic therapies, such as anti-TNF agents like infliximab or adalimumab, represent an advanced option. These medications target specific proteins involved in the inflammatory process and are used for severe or refractory cases when other treatments fail.
Dietary and Lifestyle Management
Dietary adjustments play a supportive role in managing microscopic colitis symptoms. Identifying and avoiding specific food triggers, such as caffeine, alcohol, and artificial sweeteners, may alleviate diarrhea for some. For those with sensitivities, limiting dairy products or gluten can also be beneficial. A low-FODMAP diet, which restricts certain fermentable carbohydrates, has shown promise in reducing digestive symptoms. Dietary changes are often highly individualized and may require careful observation to determine their effectiveness.
Lifestyle modifications further complement medical treatment. Stress reduction techniques, such as mindfulness or regular exercise, can be helpful, as stress may influence digestive symptoms. Smoking cessation is recommended, as smoking has been identified as a risk factor for microscopic colitis and can exacerbate symptoms. Additionally, avoiding non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen is advised, as these medications have been linked to the onset or worsening of microscopic colitis. These non-pharmacological strategies aim to reduce symptom burden and support overall gut health.
Living with Microscopic Colitis
The long-term course of microscopic colitis can vary, with some individuals experiencing spontaneous remission while others may have persistent or recurring symptoms. Many individuals can achieve sustained remission with appropriate treatment. However, recurrence is common, and some may require long-term low-dose medication to manage their condition effectively.
Ongoing communication with a healthcare provider is important for monitoring symptoms, adjusting medications as needed, and addressing any potential relapses. While microscopic colitis is a chronic condition, it is considered benign. It is not associated with an increased risk of colon cancer or other severe complications, offering reassurance to those with the diagnosis. However, some individuals may still experience symptoms like abdominal pain or fatigue even when diarrhea is in remission.